BACKGROUND & RATIONALE: Posttraumatic stress disorder (PTSD) is an often chronic and disabling condition prevalent in the Veteran population. Evidence-based treatments, including medication and psychotherapy, can reduce or relieve the symptoms of PTSD and the disability associated with it. Over the last decade, the VA has funded development of new treatments, increased mental health staffing, and provided training to deliver evidence- based PTSD treatments. However, there has been no comprehensive longitudinal analysis of the delivery of evidence-based treatments for PTSD over the initial decade of the VA's efforts to transform PTSD care. We do not know which national improvement strategies had the greatest effect on use of evidence-based treatments. We understand neither the relationship between specific implementation strategies and the uptake of specific treatments, nor how local context affects response to these improvement efforts. Furthermore, while access to mental health services has improved, there has been little evaluation of whether delivery of specific evidence-based treatments for PTSD has been timely. This information could help target efforts to improve the quality of VA PTSD care. OBJECTIVES: The broad objective of this 5-year career development program is to gain the education, mentorship, and research experience I need to launch a career as an independent investigator. My long-term goal is to improve the quality of VA PTSD care. To do this, I need to be able to measure quality, to understand what drives quality, and to design and test interventions to improve quality. My short-term goal is to develop skills in these areas. My research objectives align with my short and long-term goals. I have developed a research plan that is focused on measuring longitudinal trends in the quality of VA PTSD care, understanding the effects of national improvement efforts, and performing exploratory analyses to begin to understand how fac